Using the 4 pillars (TM) practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial

作者：Lin Chyongchiou J; Nowalk Mary Patricia^*; Pavlik Valory N; Brown Anthony E; Zhang Song; Raviotta Jonathan M; Moehling Krissy K; Hawk Mary; Ricci Edmund M; Middleton Donald B; Patel Suchita; South Paul Jeannette E; Zimmerman Richard K

来源：BMC Infectious Diseases, 2016, 16(1): 623.

DOI：10.1186/s12879-016-1940-1

• Influenza vaccine
• Immunization
• Adults

Background: An evidence-based, step-by-step guide, the 4 Pillars (TM) Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.
Methods: Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions.
Results: A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P < 0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P < 0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P < 0.005).
Conclusions: Reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars (TM) Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults.

• 出版日期2016-11-3